Statement of the Rights and Responsibilities of Family Health West Patients

Notice of Rights
The patient or the patient's representative has the right to be informed of patient rights information in advance of furnishing or discontinuing patient care, whenever possible.

Access to Care
Individuals shall be accorded impartial access to treatment or accommodations that are available or medically indicated, regardless of age, race, creed, sex, national origin, religion, sexual orientation, handicap, or sources of payment for care.

Respect and Dignity
The patient has the right to considerate, respectful care at all times and under all circumstances, with recognition of his/her personal dignity.

Privacy and Confidentiality
The patient has the right, within the law, to personal and informational privacy, as manifested by the following rights:
• To refuse to talk with or see anyone not officially connected with the hospital, including visitors, or persons officially connected with the hospital but not directly involved with his/her care.
• To wear appropriate personal clothing and religious or other symbolic items, as long as they do not interfere with diagnostic procedures or treatment.
• To be interviewed and examined in surroundings designed to assure reasonable visual and auditory privacy. This includes the right to have a person of one's own sex present during certain parts of a physical examination, treatment, or procedure performed by a health professional of the opposite sex and the right not to remain disrobed any longer than is required for accomplishing the medical purpose for which the patient was asked to disrobe.
• To expect that any discussion or consultation involving the patient's case will be conducted discreetly and that individuals not directly involved in the patient's care will not be present without the patient's permission.
• To have the patient's medical record read only by individuals directly involved in the patient's treatment or in the monitoring of its quality. Other individuals can only read the patient's medical record on the patient's written authorization or that of the patient's legally authorized representatives.
• To expect all communications and other records pertaining to the patient's medical care, including the source of payment for treatment, to be treated as confidential, except in such cases when reporting is permitted or required by law or authorized by patient.
• To be placed in protective privacy when considered necessary for personal safety.

Personal Safety
The patient has the right to expect reasonable safety insofar as the hospital practices and environment are concerned and to receive care in a safe setting. The patient further has the right to be free from all forms of abuse, harassment, neglect and exploitation.

Identity
The patient has the right to know the identity and professional status of individuals providing service to him/her. He/she has the right to know which physician or other practitioner is primarily responsible for his/her care and the name of the physician or other practitioner who will provide the care, treatment and services. This information is provided to the patient or authorized representative as soon as possible at admission, if the caregiver is not known by the patient, or at a change point of those providing care or services. The patient further has the right to know the reasons for any proposed change in professional staff responsible for the patient's care.

Information
The patient has the right to obtain, from the practitioner responsible for coordinating his/her care, complete and current information concerning his/her diagnosis (to the degree known), treatment and any known prognosis. This information should be communicated in terms the patient can reasonably be expected to understand. When it is not medically advisable to give such information to the patient, the information should be made available to a legally authorized individual.

Review of Records
The patient has the right to review records pertaining to his/her medical care in accordance with hospital policy except when such review is restricted by law. The patient has the right to access his/her medical record information within a reasonable time frame. The hospital will actively seek to meet these hospital record requests as quickly as its record keeping system permits. The patient further has the right to request amendment to and receive an accounting of disclosures regarding his or her own health information as permitted under hospital policy and applicable law.

Communication
The patient has the right of access to people outside the hospital by means of visitors and by verbal and written communication. The patient has the right to request to have a family member or representative and their own physician notified promptly upon their admission to the hospital. When the patient does not speak or understand the predominant language of the community, he/she should have access to an interpreter. This is particularly true where language barriers are a continuing problem.

Consent
The patient has the right to make informed decisions regarding his or her care, be informed of his or her health status and be involved in care planning and treatment. To the degree possible, this should be based on a clear, concise explanation of his/her condition and of all proposed technical procedures, including the possibilities of any risk of mortality or serious side effects, problems related to recuperation, and probability of success. The patient should not be subjected to any procedure without his/her voluntary, competent and understanding consent or the consent of his/her legally authorized representative. Where medically significant alternatives for care or treatment exist, the patient shall be so informed.

Consultation
The patient, at his/her own request and expense, has the right to consult with a specialist.

Refusal of Treatment
The patient may refuse treatment to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. When the patient is not legally responsible, the surrogate decision maker as allowed by law and hospital policy, has the right to refuse care, treatment and services on the patient's behalf. When refusal of treatment by the patient or his/her legally authorized representative prevents the provision of appropriate care in accordance with professional standards, the relationship with the patient may be terminated upon reasonable notice. The patient or his/her legally authorized representative may request transfer to another hospital.

Advance Directives
(Living Wills, Durable Power of Attorney for Healthcare)
The patient has the right to have an advance directive concerning treatment or designating a surrogate decision maker. The patient shall be asked if he/she has an advance directive and such information shall be included in the patient's medical record.

Transfer and Continuity of Care
The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated services. He/she has a right to know the reasons for his/her transfer within or outside the hospital.

When medically appropriate and legally permissible, or when a patient has so requested, a patient may be transferred to another facility. A patient may not be transferred to another facility or organization unless he/she has received a complete explanation of the need for the transfer and of the alternatives to such a transfer and unless the transfer is acceptable to the other facility or organization.

The patient has the right to be informed by the practitioner responsible for his/her care, or his/her delegate, of any continuing health care requirements following discharge from the hospital.

Restraint
The patient has the right to be free from restraint and seclusion of any form that are not medically necessary or are used as a means of coercion, discipline, convenience or retaliation.

Hospital Charges
Regardless of the source of payment for his/her care, the patient has the right to request and access in a reasonable period of time the cost of services, including an itemized bill if possible. The patient has the right to timely notice prior to termination of his/her eligibility for reimbursement by any third-party payer for the cost of his/her care. He/she has the right to be informed of the source of the hospital's reimbursement for his/her services, and of any limitations, which may be placed upon his/her care.

Hospital Rules and Regulations
Complaint and Grievance Process
The patient should be informed of the hospital rules and regulations applicable to his/her conduct as a patient. Patients are entitled to and informed of information regarding the hospital's complaint resolution and grievance process. Included in this information is the right to file a complaint with the state authority. Patients can freely voice complaints and recommend changes without being subject to coercion, discrimination, reprisal, or unreasonable interruption of care treatment and services.

Pain Management
The patient has the right to the appropriate assessment and management of his/her pain while considering the patient's personal, cultural, spiritual and/or ethnic beliefs and to have that pain treated as effectively as possible. The patient further has the right to be educated regarding his/her role in managing pain as well as the potential limitations and side effects of pain treatment.

The patient is responsible to ask the practitioners caring for him/her what to expect regarding pain and pain management and to help them in the assessment of his/her pain. This includes a discussion of pain relief options and working with the practitioners to develop a pain management plan. The patient is also responsible to tell his/her doctor or nurse if the pain is not relieved or if there are questions or concerns regarding his/her pain management.

Communication
A patient has the responsibility to request assistance, if needed, and provide information to assist in the contact of a family member or representative on admission. The patient further has the responsibility to request assistance and provide information to assist in location of their own physician (if he/she is not a member of the hospitals medical staff), if notification is requested on admission to the hospital.

Personal Safety
A patient is responsible to assist in the promotion of their rights to privacy and personal safety by reporting to hospital staff safety, privacy or abuse and harassment concerns. These may be reported through the question/concern or grievance resolution process.

Provision of Information
A patient has the responsibility to provide, to the best of his/her knowledge, accurate and complete information about present complaints, past illnesses, hospitalization, medications, and other matters relating to his/her health. He/she has the responsibility to report unexpected changes in his/her condition to the responsible practitioner. A patient is responsible for reporting whether he/she clearly comprehends a contemplated course of action and what is expected of him/her. A patient is responsible to ensure that the health care institution has a copy of his/her current written advance directives, if he/she has one.

Compliance with Instructions
A patient is responsible for following the treatment plan recommended by the practitioner primarily responsible for his/her care. This may include following the instructions of nurses and allied health personnel as they carry out the coordinated plan of care, implement the responsible practitioner's orders, and enforce the applicable hospital rules and regulations. The patient is responsible for keeping appointments and, when he/she is unable to do so for any reason, for notifying the responsible practitioner or the hospital.

Refusal of Treatment
The patient is responsible for his/her actions if he/she refuses treatment or does not follow the practitioner's instructions.

Hospital Charges
The patient is responsible for assuring that the financial obligations of his/her health care are fulfilled as promptly as possible.

Hospital Rules and Regulations
The patient is responsible for following hospital rules and regulations affecting patient care and conduct.

Respect and Consideration
The patient is responsible for being considerate of the rights of other patients and hospital personnel and for assisting in the control of noise, smoking, and the number of visitors. The patient is responsible for being respectful of other persons and of the hospital.

Resolution of Conflicts
The patient has a right to voice his/her concerns and have any conflicts that arise during his/her hospital stay resolved. Patients are encouraged to bring these concerns or problems to the attention of their nurse or the clinical coordinator. Patients have the right to inform the hospital of patient grievances as under the Patient Grievance Resolution Process.

Rights and Responsibilities of Neonates, Children, Adolescents and their Parents and/or Guardians
All rights and responsibilities set forth in this policy pertain to neonates, children, adolescents and their parents and/or guardians.
• Neonates, children and adolescents have a right to be represented by an advocate when parents and/or guardian preference differs from that of the medical community.
• When prolonged separation from peers is anticipated, neonates, children and adolescents have a right to have peer and group interaction.
• These individuals have a right to have their families involved in the assessment, treatment and continuing care.
• Families have a right to expect assistance in coping with illnesses that may be traumatic due to their duration, severity or effect on the patient's physical and psychological development.
• Neonates, children and adolescents have a right to a physical environment that is designed to encourage its use and provide for comfort and security.

Provision of Rights and Responsibilities Information
Written copies of the patient rights and responsibilities are provided to the patient for review on admission to the ambulatory surgical unit and the inpatient care units. Copies may also be obtained from the Admitting department.

Patient Grievance Resolution Process
The Board of Directors, Medical Staff and Management of Family Health West support our patients’ rights by providing a grievance process to respond to your concerns regarding patient rights, quality of care, patient safety or discharge readiness. We encourage you to contact us with your concerns.

You can contact us verbally or in writing by:

Verbal Grievance
Ask to speak with Patient Support Director, Angelina Salazar at 970-858-2104
or call 970-858-3900 and ask the operator to connect you with Customer Service.

Written Grievance
Write to us at:
• Family Health West Patient Support
PO Box 130
Fruita, CO 81521

You also have the right to contact:

• Colorado Department of Public Health and the Environment (CDPHE)
4300 Cherry Creek Dr. South
Denver, CO 80246
1-800-886-7689

As a Medicare patient, you have the right to contact:

• Medicare Quality Improvement Organization (QIO)
1-800-727-7086 extension 704 or (303) 695-3333

For information or to register complaints regarding Advance Directives, you have the right to contact:

Colorado Palliative Care Partnership
PO Box 50888
Colorado Springs, CO 80949
(719) 594-9233
info@coloradopalliativecare.org